In the study by Gavazzi et al10, ACM patients who continued drinking exhibited worse transplant-free survival rates after 7 years than those who stopped drinking alcohol (27% vs 45%)10. From the data provided in the available ACM studies, it appears that patients who received an ACEI globally showed improved prognosis. In contrast, beta-blockers, similar to aldosterone inhibitors, however beneficial they may be, have thus far not yielded sufficient data on their efficacy in relation to this disease.
Prediction of recovery after abstinence in alcoholic cardiomyopathy: role of hemodynamic and morphometric parameters
The majority of the echocardiographic studies performed on asymptomatic alcoholics found only mild changes in their hearts with no clear impairment of the systolic function. For example, a slight increase in the pre-ejection period/left ventricular ejection time ratio (PEP/LVET) was found by some authors, suggesting a sub-clinical impairment of systolic function21,33. Mathews and Kino found a small, but significant increase in left ventricular mass in individuals consuming at least 12 oz of whisky during 6 years and 60 g of ethanol per day, respectively22,40.
Alcoholic cardiomyopathy: incidence, clinical characteristics, and pathophysiology
Mendelian randomization (MR) studies, which use genetic variants (typically single nucleotide polymorphisms (SNPs) to reduce confounding 14), have provided valuable insights about disease specific effects of alcohol 15–17. MR studies have rarely addressed the effect of alcohol consumption on all-cause mortality, when the key question is whether benefits for cardiovascular disease outweigh the known harms of alcohol 18. Moreover, all-cause mortality as an outcome is open to selection bias because it misses those who died early (i.e., before recruitment) which can exaggerate the benefits of alcohol 19. Lifespan was based on parental attained age, as previously 20, because it has more power than participant lifespan. Using parental attained age has much more variability because there is a greater range in parental current age or age at death.
Commentary: Rheumatic valve surgery in emerging countries: New insights for an old disease
Also, there were significant size variations in the myofibrils and they showed a relative decrease in the number of striations, in addition to swelling, vacuolisation and hyalinisation. Cell nuclei were larger than normal, morphologically difficult to define and they occasionally showed hyperpigmentation. The authors highlighted the presence of an extensive intracellular accumulation of neutral lipids, principally in the form of small cytoplasmic droplets. In a subsequent study using electron microscopy, the authors found histological features that could be superimposed onto those found in hearts that had suffered hypoxia, anoxia or ischemia43. Analogous to the sarcoplasmic reticulum, the mitochondria were swollen or oedema was present, with crest alterations and intra-mitochondrial inclusions suggesting degenerative processes (Figure 2). Moreover, myofibrils showed a progressively distorted structure, resulting in a homogeneous mass.
The effects of ethanol on the heart: Alcoholic cardiomyopathy
- The lowest prevalence of ACM among DCM (3.8%) was obtained from a series of 673 patients admitted to hospital consecutively due to HF in the state of Maryland27.
- Thus, although there is a certain degree of consensus regarding the recommendation of full alcohol withdrawal in ACM, it is yet to be resolved whether moderate alcohol consumption is sufficient to achieve an improvement in the prognosis of these patients.
- However, a possible confusion factor was identified because the group with clinical improvement also exhibited a shorter evolution of the symptoms and the disease.
- The ‘Quebec beer drinkers’ cardiomyopathy’ was related to cobalt supplementation to beer that was made in the past.
Independence requires no instrument outcome confounding which was addressed by using genetic predictors of the exposure given genetics are much less confounded than observed exposures 30. We alcoholic cardiomyopathy symptoms also allowed for potential confounding by adjusting for smoking and socio-economic position. Exclusion restriction requires that the IV is independent of the outcome, given the exposure, which was addressed by sensitivity analysis for genetic pleiotropy and use of lifespan and survival to recruitment to address selection bias. Among non-tribal population, no differences in the death and survival groups were observed at the baseline in terms of age, sex, chest pain, basal crepts, orthopnoea, PND, JVP and oedema.
Epidemiological studies
The QRS duration, LVEDD and LVESD were higher but the LVEF was lower in the tribal population. To our knowledge, our study determined prognostic factors for ACM outcome in the largest cohort of ACM patients described to date. Our data show that the variables most closely predicting a poor outcome in ACM are QRS duration, SBP and NYHA classification at admission.
A pilot metabolomic study on myocardial injury caused by chronic alcohol consumption–alcoholic cardiomyopathy
- However, alcohol drinking is often heavier in men 62, perhaps because it is often related to masculinity identity and male bonding, especially among youth 63, in many settings (e.g. night life, parties) across the globe 64,65.
- Patients aged 45 and older were largely affected and cardiovascular etiologies predominated among causes for admission.
- Tenth, we may have underestimated the effect of alcohol on lifespan, because early deaths, possibly due to non-natural causes, were excluded 31.
- Additional studies including 24 hours ECG monitoring, coronary angiography and coronary artery CT were performed to rule out coronary heart disease.
Similar to estimates from MRlap those from the single SNP analysis suggested slightly greater harms of alcohol on lifespan. Ninth, we did not conduct non-linear MR in this study, so we cannot rule out the possibility of a U-shaped association of alcohol consumption with lifespan. However, MR studies are increasingly indicating that the association of alcohol with cardiovascular disease, which was thought to be non-linear, is linear 83. Similarly, a recent observational study also suggested harms of any level of regular (rather than occasional) alcohol use 84. Tenth, we may have underestimated the effect of alcohol on lifespan, because early deaths, possibly due to non-natural causes, were excluded 31. Eleventh, we conducted a partly one-sample study using two sample methods, which could bias particularly the MR-Egger estimates 48.
Study design:
Patients aged 45 and older were largely affected and cardiovascular etiologies predominated among causes for admission. Globally alcohol consumption varies considerably with cultural norms, alcohol tolerance and gender. Alcohol consumption is one of the four target behaviors proposed by the World Health Organization (WHO) in 2014 as harmful to health and in need of change 1. Nevertheless, controversy remains about the role of alcohol 2 particularly at older ages, where alcohol appears to protect against all-cause mortality, despite being harmful at younger ages 3. No trials of the effects of use of alcohol on mortality have been conducted or are likely to be conducted given alcohol is a known carcinogen 4 although a large-scale trial would be definitive 5.
Alcohol abuse and heart failure
In spite of numerous studies, the sequence of events that occur in alcohol-induced myocardial damage is still highly controversial. Although some authors contend that the initial event is the appearance of hypertrophy, the majority accept that the core event is the loss of cardiomyocytes. Epidemiological studies analysing the relationship between excessive alcohol consumption and the development of DCM have found the existence of a reciprocal link between both disorders. Numerous studies have shown conflicting results regarding the natural history and outcomes with alcoholic cardiomyopathy (AC). Another nutritional factor classically involved in the pathophysiology of AC was cobalt excess. The ‘Quebec beer drinkers’ cardiomyopathy’ was related to cobalt supplementation to beer that was made in the past.